Bowel EliminationNUR101 Fall 2008Lecture # 23K. Burger, MSEd, MSN, RN, CNE

PPP By: Sharon Niggemeier RN MSN

J Borrero 12/08

Functions of the GI Tract

• Prepare fluids and nutrients for absorption and use by cells via mechanical and chemical breakdown

• Absorb fluids and nutrients

• Receives secretions from organs (eg. gallbladder, pancreas)

Anatomy & Physiology• Organs of the GI tract?• Function of Large intestine: absorption Extends from Ileocecal valve to

anus• Chyme• Peristalsis & Mass peristalsis

Act of Defecation

• Defecation reflex

• Valsalva maneuver

• Defecation

Alteration in Bowel Elimination

• Diarrhea

• Constipation

• Incontinence

• Fecal Impaction

• Flatulence

Characteristics of Stool

• Volume

• Color

• Odor

• Consistency

• Shape

• Constituents

Factors That Influence Bowel Elimination

• Age

• Fluid Intake & Diet

• Daily Routine

• Activity

• Medications

• Health Status

• Stress

Diet

High fiber foods:

• Legumes (beans)

• Cereals

• Whole grains

• Raw Fruits

• Vegetables

Laxative effect foods:

• Spicy & greasy

• Bran/Chocolate

• Coffee/Alcohol

• Raw fruits & vegetables

Assessing Elimination Status

• Usual pattern

• Changes in bowels

• Aids to eliminate

• Current problems

Physical Assessment • Inspection- observe contour of abd and

note visible peristalsis• Auscultation- listen for bowel sounds all

quadrants• Percussion- resonant or tympany over

hollow organs…dullness over intestinal obstruction

• Palpation- feel for masses, tenderness etc…

Stool Specimen Collection

• Routine specimen

• Occult blood

• Ova & parasite

• Timed specimens

Nursing Dx R/T Bowel Elimination

?

Outcome Criteria

• Pt. will:

• Develop regular pattern of elimination

• Have less episodes of incontinence

• Incorporate fluids/diet that promote bowel elimination

Interventions to Promote Elimination

• Routine• Positioning• Privacy• Comfort• Activity • Diet/Fluids

Interventions: Promote Bowel Elimination

• Laxatives and Cathartics

• Enemas

• Suppositories

• Digital Removal

Types of Enemas

C lean s in g R eten tion R etu rn F low

Typ es o f E n em as

Enema Solutions

• Tap water (Hypotonic)

• Normal saline (Isotonic)

• Soap

• Hypertonic

• Oil

Tap Water (TWE)

• Amount: 500-1000cc• Action: Distends, increases peristalsis• Time: 15 min.• Indicated: inflamed bowels/irritated

colon• Contraindicated: Atonic bowels, fluid

restrictions

Normal Saline

• Amount: 500-1000cc

• Action: Distends, increases peristalsis

• Time: 15 min.

• Indicated:Inflamed bowels/irritated colon

• Contraindicated: Na retention problems, fluid restrictions

Soap (SSE)

• Amount: 500-1000cc (Castile 5ml/1000cc)

• Action: Distends, Irritates

• Time: 15 min.

• Indicated: Constipation

• Contraindicated: Prior to rectal exams

Hypertonic

• Amount: 70-130 cc solution

• Action: Distends/Irritates

• Time: 5-10 min.

• Indicated: Constipation, convenience

• Contraindicated: Dehydration, Na problems

Oil Retention

• Amount: 120-200cc

• Action: Lubricates

• Time: 30 min.

• Indicated: Fecal impaction

• Contraindication: none

Enema Administration

• PPE

• Position L Sims

• Linen protector

• Receptacle (bedpan, commode, toilet)

• IV pole

• Lubricant

• Enema bag with solution

• Tissue paper

Enema Administration

• Position L Sims

• Insert lubricated tip 4”

• Bag raised 18-20” above anal canal

• Administer slowly - 10 min.

• Administration is individualized.

• Pt. holds for 15 min.

Evaluation

• Solution given

• Amount expelled

• Characteristics of stool

• Passing of flatus

• Unusual findings blood, helminthes, pus etc.

• Client reaction: change in skin color, VS changes, fatigue

Medications Effecting Bowel Elimination

• Laxatives- induce emptying of GI tract

• Antidiarrheal- slow peristalsis, Pepto Bismol, Kaopectate

• Codeine/morphine/iron- cause constipation

• Antibiotics-may cause diarrhea

• Opiates: paragoric, lomotil- habit forming

Flatulence

Causes:

• Decreased peristalsis

• Constipation• Medications• Surgery

• Diet

• Stress

• Decreased activity

NonInvasive Interventions for Flatulence

*Ambulation*

• Knee chest position

Invasive Interventions for Flatulence

• Glycerin Suppository

• Harris Flush

• Rectal Tube

Evaluation of Bowel Function

• Achievement of regular defecation habits• Patient’s understanding of normal

elimination• Maintenance of adequate food and fluid

intake• Regular exercise program• Comfort• Skin integrity

Gastrointestinal Charting Chuckles The patient had waffles for breakfast and anorexia for lunch.

She stated that she had been constipated for most of her life until 1989, when she got a divorce.

Bleeding started in the rectal area and continued all the way to Los Angeles.

Rectal examination revealed a normal-size thyroid. The patient was to have a bowel resection. However, he took a job

as a stockbroker instead. Fleet enema given with stool hard as pine knots.

Patient complains of indigestion since last night when he ate a stake. Patient passed flatus . . . two short, one long.

Patient was seen in consultation by the physician, who felt we should sit tight on the abdomen, and I agreed.